A new report by the World Health Organisation on the global use of tobacco shows India, Bangladesh and Bhutan on top of the list of South East Asian countries that have achieved a high level of tobacco control.

The prevalence of tobacco use in India has fallen from 34.1 per cent to 28.6 per cent over the last seven years, the report says, comparing data from two rounds of the Global Adult Tobacco Survey (GATS) in 2009-10 and 2016-17.

The WHO report titled Global Tobacco Epidemic, 2017: Monitoring Tobacco Use and Prevention Policies, was released in New York on Wednesday on the sidelines of the United Nations High-Level Political Forum on Sustainable Development. The report covers 194 countries, divided into The Americas, South East Asia, Europe, Eastern Mediterranean, Western Pacific, and Africa. There are 11 countries in the South East Asia group, including India.

Though the population worldwide protected by tobacco control measures has grown almost five-fold than ten years ago, the World Health Organisation (WHO) on Wednesday called on countries to do more to prioritise these life-saving policies.

In India, Mumbai, Kolkata, Delhi, Hyderabad, Bengaluru, Pune, Surat, Kanpur, Jaipur, Lucknow and Nagpur are among the top 100 cities across the world named for the strict implementation of policies to prevent tobacco use. The report lists the cities population-wise, using figures published in the UN Statistics Division’s Demographic Yearbook.

Globally, the WHO report said about 4.7 billion people, or 63 per cent of the world’s population, are covered today by at least one comprehensive tobacco control measure. Ten years ago, in 2007, the number was only one billion, or 15 per cent of the world’s population.

However, tobacco use has still become the leading single preventable cause of death worldwide, killing over seven million people each year.

Its economic costs are also enormous, totalling more than $1.4 trillion in healthcare and lost productivity, according to WHO.

Meanwhile, the tobacco industry continues to hamper government efforts to fully implement life- and cost-saving interventions, by, for example, exaggerating the economic importance of the tobacco industry, discrediting proven science, and using litigation to intimidate governments, the report says.

Poor countries ahead
More than half of the top national performers on tobacco control are low- and middle-income countries, showing that progress is possible regardless of economic situation. A tracking of MPOWER measures – introduced by WHO in 2007 to assist in the country-level implementation of measures to reduce the demand for tobacco – has revealed that the number of people protected by at least one best-practice measure has quadrupled to 4.7 billion – or almost two-thirds of the world’s population.

As many as 121 out of 194 countries have introduced at least one MPOWER measure at the highest level of achievement (not including monitoring or mass media campaigns, which are assessed separately).

Thirty-four countries with a total population of 2 billion have adopted large graphic pack warnings. Six countries (Afghanistan, Cambodia, El Salvador, Lao People’s Democratic Republic, Romania and Uganda) have adopted new laws making all indoor public places and workplaces smoke-free. Six countries (El Salvador, Estonia, India, Jamaica, Luxembourg and Senegal) have advanced to best-practice level with their tobacco use cessation services, the report says.

India and Nepal are regional and global leaders in implementing large, pictorial warning labels on tobacco packaging. With the increase in the size of pack warnings to 85 per cent of both front and back panels on all tobacco products, India now has the third largest pack warning label among all countries.

The findings of GATS-2 showed that graphic warning labels depicting throat cancer and oral cancer are a strong tool to discourage the youth from initiating tobacco, and have motivated 275 million current users to quit.

Dr Vinayak Prasad, Geneva-based head of the WHO Tobacco Free Initiative, told The Indian Express that among the many measures to control tobacco in India was the joint WHO-International Telecommunication Union initiative mCessation, launched in 2015 with the Ministries of Health and Family Welfare and Communication and Information Technology. ”The programme to encourage people to quit tobacco use registered more than two million users last year and the initial evaluation showed that more than 7% quit successfully after six months,” Dr Prasad said.

The WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty negotiated under the auspices of WHO, was adopted by the World Health Assembly in 2003, and entered into force in 2005. It has since become one of the most widely embraced treaties in UN history.

A new report by the World Health Organization (WHO) shares some good news: Six in 10 people worldwide are now protected by at least one of the WHO Framework Convention on Tobacco Control (FCTC)-recommended demand reduction measures, including taxation. The report, launched on the sidelines of the UN high-level political forum on sustainable development, also makes clear that raising taxes to increase tobacco product prices is the most cost-effective means to reduce tobacco use and prevent initiation among the youth. But it is still one of the least used tobacco control measures.

Tobacco use is the leading single preventable cause of death worldwide, killing over 7 million people each year.

Cigarettes are addictive by design, and smoking cigarettes can damage every part of the body, causing different cancers from the head or neck to the lungs and cervix and other chronic conditions such as stroke and heart disease, which lead to early death.

The direct and indirect economic costs are also enormous, totaling more than US$1.4 trillion.

Controlling tobacco use is critical for the achievement of the health and social and economic targets in the 2030 Agenda for Sustainable Development.

But we know what needs to be done and governments are acting. Governments are implementing “MPOWER”, six tobacco control measures in line with the WHO Framework Convention on Tobacco Control (FCTC). MPOWER includes:

Monitoring tobacco use and prevention policies;

Protecting people from tobacco smoke;

Offering help to quit tobacco use;

Warning about the dangers of tobacco;

Enforcing bans on tobacco advertising, promotion and sponsorship; and

Raising tobacco taxes.

The WHO report indicates that 43% of the world’s population (3.2 billion people) are now covered by two or more MPOWER measures at the highest level, nearly seven times the number covered in 2007. Eight countries, including five low- and middle-income ones, have implemented four or more MPOWER measures at the highest level: Brazil, Islamic Republic of Iran, Ireland, Madagascar, Malta, Panama, Turkey, and the United Kingdom of Great Britain and Northern Ireland.

Some additional findings are noteworthy:

Monitoring: Several countries, such as Nepal, India, and the Philippines, that conducted WHO-backed initiatives to monitor tobacco use have used the information to adopt measures to protect people from tobacco use. For example, Philippines’ landmark Sin Tax Reform Law was passed in 2012 after its 2009 global adult tobacco survey showed high smoking rates among men (47.4%) and boys (12.9%). The implementation of this policy measure has contributed to declining tobacco use as evidenced by the country’s 2015 adult tobacco survey results.

Protect: Comprehensive smoke-free legislation is currently in place for almost 1.5 billion people in 55 countries. Dramatic progress has been witnessed in low- and middle-income countries, 35 of which have adopted these laws since 2007.

Offer: Appropriate cessation treatment is in place for 2.4 billion people in 26 countries.

Warn: More people are protected by strong graphic pack warnings than by any other MPOWER measure, covering almost 3.5 billion people in 78 countries – almost half (47%) the global population. And, 3.2 billion people live in a country that aired at least one comprehensive national anti-tobacco mass media campaign in the last two years.

Enforce: Bans on tobacco advertising, promotion, and sponsorship interfere with the tobacco industry’s ability to promote and sell its deadly products and reduce tobacco use. But only 15% of the world’s population is currently covered by a comprehensive ban.

Raise: Raising taxes to increase tobacco product prices is the most cost-effective measure to reduce tobacco use and encourage users to quit, but it is one of the least used tobacco control measures globally.

What the World Bank Group is doing

As an institution, the Bank has long been committed to tobacco control as reflected in its unambiguous Operational Directive 4.76 of 1999 that mandates that the World Bank Group does not lend directly or provide credits, grants, or guarantees for tobacco production, processing, or marketing. The Bank’s policy advice and technical assistance support tobacco tax increases to protect the population from health risks and to mobilize additional domestic resources.

Over the past two decades, Bank teams have carried out substantial analytical work to build the global knowledge base on issues related to tobacco control.

In recent years, the Bank, in partnership with the Gates and Bloomberg Foundations, and in coordination with WHO, has supported countries in the design of tobacco tax policy reforms to raise prices, reduce consumption, and mobilize domestic resources in accordance with the 2015 Financing for Development Addis Ababa Action Agenda.

In addition to support provided to the reforms in Philippines in 2012, in Botswana in 2013, in Ghana in 2014, and in Peru in 2015, the Bank’s assistance to Armenia, Colombia, Moldova, and Ukraine contributed to the adoption of significant tobacco tax increases in 2016. The total population covered by these policy actions is about 250 million people.

Ongoing support is being provided in 2017 to an additional set of countries across regions, including Montenegro, where the government recently announced that tobacco taxes will be increased over the next 3 years in line with the European Union Tobacco Tax Directive’s target rates, and in Lesotho, as part of the 2017 budget presented by the new government to Parliament.

In moving the global tobacco control agenda forward, as the findings of the 2017 WHO report suggest, a dedicated focus by governments with support of the international community is required to raise tobacco taxes since it continues to be the least used tobacco control measure. This is of critical importance to make these deadly products unaffordable, reduce consumption among current smokers, and prevent smoking initiation among children and youth.

While health is the main objective, we also need to argue, on the basis of country evidence from across the world, that raising tobacco taxes can generate a significant fiscal benefit by helping to expand a country’s tax base and increase the budgetary capacity of governments to fund priority investments and programs that benefit the entire population.

In fact, the trend has caught on so rampantly that it’s set to outsell traditional cigarettes by the end of 2023!

With the FDA regulating these products since 2016, it comes as no surprise that vaping is due to become the norm, surpassing traditional smoking in time to come.

In a report on the use of e-cigarettes in Canada, a report previously stated that “Among those whose primary reason for use is to help to quit tobacco, a similar proportion no longer smoke (24%), and this may be considered the success rate for this method of smoking cessation.”

How is vaping different from smoking?

To differentiate itself from tobacco products, vaping is the process of smoking nicotine without inhaling the other harmful substances in tobacco—out of which there 70 known carcinogens. Some products contain little to no nicotine in them. Canada for instance still does not approve of nicotine-containing e-cigarettes.

These battery-powered devices heat the liquid that contains nicotine and/or other flavours, which in turn is inhaled as the vapour.

There is no smoke without fire, however

Since the key objective of switching to e-cigarettes is to cut down the number of cigarettes you smoke, researchers have been assessing the ‘relative harm’ vaping can cause to your tissues.

A study conducted by Jessica Wang-Rodriguez, a head and neck cancer specialist at the University of California at San Diego and her team found that cells lining human organs sustained up to twice the DNA damage seen in unexposed cells. They were also five to 10 times more likely to wither and die than unexposed cells even if the vapour contained no nicotine, the addictive ingredient in conventional and most electronic cigarettes, as reported in New Scientist.

“Without the nicotine, the damage is slightly less, but still statistically significant compared with control cells,” says Wang-Rodriguez, who led the research.

The toxins from the flavouring are another cause of concern

“E-cigarette vapour is known to contain a range of toxins which include impurities in the e-cigarette liquids and toxins generated when solutions are heated to generate vapour,” says John Britton, a toxicologist at the University of Nottingham, UK. “Some are carcinogenic, so it’s likely some long-term users of e-cigarettes will experience adverse effects on their health, and the authors fo the study conducted by Rodriguez and company are correct to point out that these products should not be considered risk-free,” he says. But if smokers can’t give up completely, e-cigarettes are safer than smoking, he says, as reported in New Scientist.

They caused considerable damage to your key blood vessels; similar to normal cigarettes

A study conducted by researchers at the European Society of Cardiology Congress in Rome states that vaping has an impact similar to the what normal cigarettes have on the stiffening of you heart’s aorta, as reported the Independent, UK.

The lead researcher, Professor Charalambos Viachopoulos of the University of Athens said, “We measured aortic stiffness. If the aorta is stiff you multiply your risk of dying, either from heart diseases or from other causes. “There could be long-term heart dangers. They are far more dangerous than people realise.”

The problem lies with the rising number of teens taking to smoking E-cigarettes

A 2014 high school survey conducted in the US found that 17 percent of 12th graders reported the use of e-cigarettes compared to 14 percent who smoked traditional cigarettes. The lower price points at which they are promoted, their perception of being safer than traditional cigarettes, the various flavours they come in and the fact they’re in trend make it a very attractive option for the youth.

Adolescents and young adults who try e-cigarettes are more than three times as likely to take up smoking traditional cigarettes as their peers who haven’t tried the devices, states a recent research review published in Reuters Health.

E-cigarette use, or vaping, was as least as strong a risk factor for smoking traditional cigarettes as having a parent or sibling who smokes or having a risk-taking and thrill-seeking personality, the researchers found.

“E-cigarette use among teens and young adults could increase the future burden of tobacco by creating a new generation of adult smokers who might have otherwise not begun smoking,” said lead study author Samir Soneji of the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire.

“To the extent that e-cigarette use mimics the behaviour of smoking a cigarette—handling the e-cigarette, the action of puffing, and the inhalation of smoke—it sets the adolescent up for easily transitioning to smoking,” added Soneji. “Like transitioning from driving a Tesla to driving a Chevy.”

Dr Brian Primack, a researcher at the University of Pittsburgh stated that “Young people report that there is a lot of pressure among e-cigarette only users to smoke a ‘real’ cigarette,” Primack said by email. “It may be somewhat analogous to the fact that teens who use flavoured alcohol are often pressured socially to step up their game to harder forms of alcohol.”

Although e-cigarettes claim to be less harmful than conventional cigarettes it could make sense to pay heed to the lack of conclusive long-term evidence

Cigarette smokers are well aware of the perils of smoking normal cigarettes. The New England Journal of Medicine states that smoking tobacco reduces your life span by at least 10 years. But studies on smoking e-cigarettes remain largely inconclusive.

A review of studies published in the journal Tobacco Control reveals that the long-term effects of the vaporised form are not known yet. For instance, it is not known if the chemical propylene glycol, which is mixed with the other chemicals in e-cigarettes known to irritate the respiratory tract, could result in lung problems after decades of vaping, says Dr Michael Siegel, a tobacco researcher and professor of community health sciences at the Boston University School of Public Health in Live Science.

Besides, “because e-cigarettes have been on the market for only about 10 years, there have been no long-term studies of people who have used them for 30 to 40 years. Therefore, the full extent of e-cigs’ effects on heart and lung health, as well as their cancer-causing potential, over time is not known,” says Stanton Glantz a professor of medicine and the director of the Center for Tobacco Control Research and Education at the University of California, San Francisco to Live Science.

World No Tobacco Day 2017: Beating tobacco for health, prosperity, the environment and national development

http://www.who.int/mediacentre/news/releases/2017/no-tobacco-day/en/

Action to stamp out tobacco use can help countries prevent millions of people falling ill and dying from tobacco-related disease, combat poverty and, according to a first-ever WHO report, reduce large-scale environmental degradation.

On World No Tobacco Day 2017, WHO is highlighting how tobacco threatens the development of nations worldwide, and is calling on governments to implement strong tobacco control measures. These include banning marketing and advertising of tobacco, promoting plain packaging of tobacco products, raising excise taxes, and making indoor public places and workplaces smoke-free.

Tobacco’s health and economic costs

Tobacco use kills more than 7 million people every year and costs households and governments over US$ 1.4 trillion through healthcare expenditure and lost productivity.

Dr Chan adds: “But by taking robust tobacco control measures, governments can safeguard their countries’ futures by protecting tobacco users and non-users from these deadly products, generating revenues to fund health and other social services, and saving their environments from the ravages tobacco causes.”

All countries have committed to the 2030 Agenda for Sustainable Development, which aims to strengthen universal peace and eradicate poverty. Key elements of this agenda include implementing the WHO Framework Convention on Tobacco Control, and by 2030 reducing by one third premature death from noncommunicable diseases (NCDs), including heart and lung diseases, cancer, and diabetes, for which tobacco use is a key risk factor.

Tobacco scars the environment

The first-ever WHO report, Tobacco and its environmental impact: an overview, also shows the impact of this product on nature, including:

Tobacco smoke emissions contribute thousands of tons of human carcinogens, toxicants, and greenhouse gases to the environment. And tobacco waste is the largest type of litter by count globally.

Up to 10 billion of the 15 billion cigarettes sold daily are disposed in the environment.

Cigarette butts account for 30–40% of all items collected in coastal and urban clean-ups.

Tobacco threatens women, children, and livelihoods

Tobacco threatens all people, and national and regional development, in many ways, including:

Poverty: Around 860 million adult smokers live in low- and middle-income countries. Many studies have shown that in the poorest households, spending on tobacco products often represents more than 10% of total household expenditure – meaning less money for food, education and healthcare.

Children and education: Tobacco farming stops children attending school. 10%–14% of children from tobacco-growing families miss class because of working in tobacco fields.

Women: 60%–70% of tobacco farm workers are women, putting them in close contact with often hazardous chemicals.

“Many governments are taking action against tobacco, from banning advertising and marketing, to introducing plain packaging for tobacco products, and smoke-free work and public places,” says Dr Oleg Chestnov, WHO’s Assistant Director-General for NCDs and Mental Health. “But one of the least used, but most effective, tobacco control measures to help countries address development needs is through increasing tobacco tax and prices.”

Governments collect nearly US$ 270 billion in tobacco excise tax revenues each year, but this could increase by over 50%, generating an additional US$ 141 billion, simply from raising taxes on cigarettes by just US$ 0.80 per pack (equivalent to one international dollar) in all countries. Increased tobacco taxation revenues will strengthen domestic resource mobilization, creating the fiscal space needed for countries to meet development priorities under the 2030 Agenda.

“Tobacco is a major barrier to development globally;” says Dr Douglas Bettcher, Director of WHO’s Department for the Prevention on NCDs. “Tobacco-related death and illness are drivers of poverty, leaving households without breadwinners, diverting limited household resources to purchase tobacco products rather than food and school materials, and forcing many people to pay for medical expenses.”

“But action to control it will provide countries with a powerful tool to protect their citizens and futures,” Dr Bettcher adds.

Editor’s note

Tobacco-related illness is one of the biggest public health threats the world faces, killing more than 7 million people a year. But tobacco use is one of the largest preventable causes of noncommunicable diseases.

Tobacco control represents a powerful tool in improving health in communities and in achieving the Sustainable Development Goals (SDGs). SDG target 3.4 is to reduce premature deaths from NCDs by one third by 2030, including cardiovascular and chronic respiratory diseases, cancers, and diabetes.

Another SDG target, 3.a, calls for implementation of the WHO Framework Convention for Tobacco Control (WHO FCTC). The WHO FCTC entered into force in 2005, and its Parties are obliged to take a number of steps to reduce demand and supply for tobacco products. Actions addressed in the Convention include protecting people from exposure to tobacco smoke; banning tobacco advertising, promotion and sponsorship; banning sales to minors; requiring health warnings on tobacco packaging; promoting tobacco cessation; increasing tobacco taxes; and creating a national coordinating mechanism for tobacco control. There are 180 Parties to the Convention.

Smoking and other tobacco use kills more than seven million people each year, the World Health Organization said Tuesday, also warning of the dire environmental impact of tobacco production, distribution and waste.

The UN agency said tougher measures were needed to rein in tobacco use, urging countries to ban smoking in the workplace and indoor public spaces, outlaw marketing of tobacco products and hike cigarette prices.

“Tobacco threatens us all,” WHO chief Margaret Chan said in a statement.

In a report released ahead of World No Tobacco Day on Wednesday, WHO warned that the annual death toll of seven million people had jumped from four million at the turn of the century, making tobacco the world’s single biggest cause of preventable death.

And the death toll is expected to keep rising, with WHO bracing for more than one billion deaths this century.

“By 2030, more than 80 percent of the deaths will occur in developing countries, which have been increasingly targeted by tobacco companies seeking new markets to circumvent tightening regulation in developed nations.”

Tobacco use also brings an economic cost: WHO estimates that it drains more than $1.4 trillion (1.3 trillion euros) from households and governments each year in healthcare expenditures and lost productivity, or nearly two percent of the global gross domestic product.

In addition to the health and economic costs linked to smoking, the WHO report for the first time delved into the environmental impact of everything from tobacco production to the cigarette butts and other waste produced by smokers.

“From start to finish, the tobacco life cycle is an overwhelmingly polluting and damaging process,” WHO Assistant Director-General Oleg Chestnov said in the report.

The report detailed how growing tobacco often requires large quantities of fertilisers and pesticides, and it warned that tobacco farming had become the main cause of deforestation in several countries.

This is largely due to the amount of wood needed for curing tobacco, with WHO estimating that one tree is needed for every 300 cigarettes produced.

WHO also highlighted the pollution generated during the production, transport and distribution of tobacco products.

The report estimates that the industry emits nearly four million tonnes of carbon dioxide equivalent annually — the same as around three million transatlantic flights.

And waste from the process contains over 7,000 toxic chemicals that poison the environment, including human carcinogens, WHO said.

Once in the hands of the consumer, tobacco smoke emissions spewed thousands of tonnes of human carcinogens, toxic substances and greenhouse gases into the environment.

Cigarette butts and other tobacco waste make up the largest number of individual pieces of litter in the world, the agency said.

Two thirds of the 15 billion cigarettes sold each day are thrown on to the street or elsewhere in the environment, it said, adding that butts account for up to 40 percent of all items collected in coastal and urban clean-ups.

WHO urged governments to take strong measures to rein in tobacco use.

“One of the least used, but most effective tobacco control measures… is through increasing tobacco tax and prices,” Chestnov said.